Little research has been done on therapeutic alliance in group psychotherapy, especially the impact of treatment duration and therapist professional characteristics.
Therapeutic alliance was rated by patients on the Working Alliance Inventory-Short Form at three time points (sessions 3, 10 and 17) in a randomized controlled trial of short-term and long-term psychodynamic group psychotherapy. As predictors we selected therapist clinical experience and length of didactic training, which have demonstrated ambiguous results in previous research. Linear latent variable growth curve models (structural equation modeling) were developed for the three Working Alliance Inventory-Short Form subscales bond, task and goal.
We found a significant variance in individual growth curves (intercepts and slopes) but no differential development due to group length. Longer therapist formal training had a negative impact on early values of subscale task in both treatments. There was an interaction between length of the therapists' clinical experience and group length on early bond, task and goal: therapists with longer clinical experience were rated lower on initial bond in the long-term group but less so in the short-term group. Longer clinical experience influenced initial task and goal positively in the short-term group but was unimportant for task or significantly negative for goal in the long-term group.
There was no mean development of alliance, and group length did not differentially impact the alliance during 6 months. Early ratings of the three Working Alliance Inventory-Short Form subscales partly reflected different preparations of patients in the two group formats, partly therapist characteristics, but more research is needed to see how these aspects impact alliance development and outcome. Therapists should pay attention to all three aspects of the alliance, when they prepare patients for group therapy.
In psychodynamic groups, length of therapy does not differentiate the overall level or the development of member-leader alliance. Within psychodynamic groups, each individual appear to have their unique perception of the member-leader alliance. Therapists with longer formal psychotherapy training may be less successful in establishing early agreement with patients on the tasks of psychodynamic group psychotherapy. Patients perceive a somewhat lower degree of early emotional bonding with the more clinically experienced therapists in long-term psychodynamics groups. Therapists with more clinical experience may contribute to a stronger degree of initial agreement with patients on the tasks and goals of short-term group psychotherapy.
To investigate the determinants of the therapeutic working relationship and better understand its intrapersonal and interpersonal nature, this study investigated therapist characteristics as predictors of the formation and development of patient-rated and therapist-rated working alliances within a clinical trial of short-term versus long-term therapies. Short-term (solution-focused and short-term psychodynamic) and long-term (long-term psychodynamic therapy and psychoanalysis) therapies were provided by 70 volunteering, experienced therapists to 333 patients suffering from depressive and/or anxiety disorders. Therapists' professional and personal characteristics, measured prior to the start of the treatments, were assessed with the comprehensive self-report instrument, Development of Psychotherapists Common Core Questionnaire. The Working Alliance Inventory was rated by both therapists and patients at the third session and at the 7?months' follow-up point from the initiation of therapy. Therapists' self-rated basic interpersonal skills were found to predict the formation of better patient-rated alliances in both short-term and long-term therapies. Engaging, encouraging relational style fostered improvement of patients' working alliances especially in the course of short-term therapies. However, it led to patient alliance deterioration in long-term therapies, where constructive coping techniques proved more beneficial. Therapists' professional self-confidence and work enjoyment, along with their self-experiences in personal life, consistently predicted their alliances, but were less salient for patient ratings of alliance. The divergence of therapist and patient viewpoints has implications for therapist training and supervision, as characteristics found detrimental or helpful for the working relationship rated from the perspective of one party may not be predictive of the other therapy participant's experience.
This study reports on follow-up meetings of a group treatment program for intimately violent men. The focus is on the construction of change narratives; on how indicators of 'successful change' are negotiated and produced in the conversations. We describe in detail five discursive strategies used by client and therapist participants, e.g., the construction of temporal differences, personalizing the problem, reformulations of failure stories, taking presence at the follow-up as evidence of success, and the use of out-siders as an audience. We also demonstrate how the notion of success is ascertained and to whom credit is given for achieving it. We conclude that the followup meetings are established as an integrated part of the whole treatment program, and contribute to the promotion of the treatment ideology.
Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM system that provides session-by-session feedback on clients' well-being and the alliance. Adult individuals (N = 170) referred for hospital-based outpatient mental health treatment were randomized to individual psychotherapy either with the PCOMS ROM system, or without (treatment as usual [TAU]). Treatment was provided by the same therapists (N = 20) in both conditions. A multilevel mediation model was developed to test if there was a significant indirect effect of ROM on client impairment at posttreatment through the alliance at 2 months' treatment controlled for first-session alliance. Alliance ratings increased more from session 1 to 2 months' treatment in the ROM than TAU condition, and alliance increase was associated with less posttreatment impairment. A significant indirect effect of ROM on treatment outcomes through alliance increase (p = .043) explained an estimated 23.0% of the effect of ROM on outcomes. The results were consistent with a theory of the alliance as one mechanism through which ROM works. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Clinical experience and previous investigations suggest that insight-oriented milieu therapy with psychotic patients presupposes a specific balance of explorative and supportive factors in the milieu. Explorative and supportive factors were translated here to two optimal ward atmosphere profiles using the subscales in the Community-oriented Programs Environment Scale (COPES) as profile variables. Three Swedish therapeutic communities for psychotic patients were then studied by means of COPES. The study showed distinct patterns in these units regarding deviations from the optimal profiles, differences in the balance between the explorative and supportive factors, divergences between explicit treatment philosophy and the perceived ward atmosphere, and differences between patient and staff perceptions of the ward atmosphere. These patterns followed a continuum from a self-governing, nonhierarchical and nonmedical organization to a hierarchical unit that is an integral part of the medical care organization. The conclusion was that a beneficial psychotherapeutic environment requires consistency in the applied treatment model, including an organization and setting that corresponds to the explicit treatment philosophy, well mirrored in the patients' perceptions.
The frame of psychotherapy shows both universality and social relativity. Since the intrapsychic world is permeable to social reality, the meaning of insurance in psychotherapy depends on context. Experience with Canadian National Health Insurance suggests that when no-fee psychotherapy in normative, it is absorbed in the frame. There are still trouble spots in the Canadian system, particularly the management of missed sessions. Depending on the needs of the patient, charging for missed sessions can disrupt therapy entirely or be constructive for the treatment.
OBJECTIVE: To investigate and compare the treatment effects of psychodynamic group therapy (PGT) and body awareness group therapy (BAGT) as outpatient treatment following day treatment for personality disorders. MATERIALS AND METHODS: Twenty-one female patients given PGT were compared with 29 female patients receiving BAGT. The average length of outpatient therapy was 24 and 25 months, respectively. The patients were assessed trough the quality assurance system of the Norwegian Network of Psychotherapeutic Day Hospitals, including the Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) for diagnostic purposes. Outcome was assessed using the Global Assessment of Functioning (GAF), Symptom Check List 90-R sum score (Global Severity Index, GSI), Circumplex of Interpersonal Problems (CIP), at admission and at discharge from day treatment, and at the end of outpatient group therapy. RESULTS: Patients undertaking BAGT improved significantly on GAF, GSI and CIP, and reported high ratings of satisfaction with therapy and group climate at the end of outpatient treatment. The magnitude of change on GAF and CIP was significantly higher in the BAGT group compared with the PGT patients who displayed only minor changes after outpatient treatment. CONCLUSIONS: BAGT is possibly an effective outpatient continuation therapy for women with severe personality disorders, but because of limitations of this study, these results warrant a larger randomized study.